Importance of cellular immunity link for efficiency of replacement therapy in common variable immune deficiency

Lifetime use of IgG replacement therapy is the standard of CVID treatment. However, full control over stabilization of chronic infection loci is not always achieved, even if this therapy is continuously applied. The purpose of this study was to carry out comparative analysis of changes in cellul...

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Autores principales:	L. P. Sizyakina, I. I. Andreeva, D. I. Danilova
Formato:	article
Lenguaje:	RU
Publicado:	SPb RAACI 2020
Materias:	cvid ivig replacement therapy cellular immunity Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/f0bad738bf3d4c41a2eb983efc55e517
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spelling	oai:doaj.org-article:f0bad738bf3d4c41a2eb983efc55e5172021-11-18T08:03:50ZImportance of cellular immunity link for efficiency of replacement therapy in common variable immune deficiency1563-06252313-741X10.15789/1563-0625-IOC-1989https://doaj.org/article/f0bad738bf3d4c41a2eb983efc55e5172020-08-01T00:00:00Zhttps://www.mimmun.ru/mimmun/article/view/1989https://doaj.org/toc/1563-0625https://doaj.org/toc/2313-741XLifetime use of IgG replacement therapy is the standard of CVID treatment. However, full control over stabilization of chronic infection loci is not always achieved, even if this therapy is continuously applied. The purpose of this study was to carry out comparative analysis of changes in cellular component of adaptive and innate immune response, depending on effectiveness of replacement therapy of patients with infectious CVID phenotype. The observation group consisted of 15 patients with CVID who were diagnosed since early childhood in 100% of cases. They had prolonged respiratory infections followed by the development of complications requiring continuous treatment with antibiotics.After reaching mean age of 15 years old, the intensity of infection-associated antibody deficiency was 6-8 times per year. After verification of the diagnosis, the patients received replacement therapy, first at the saturation dose, and, after stabilization of IgG at the level of 7-8 g/l, at the monthly maintenance dose. The clinical course of the disease was traced during a full year of replacement therapy, and the cellular immunity indices were evaluated. In all patients, after a year of therapy corresponding to clinical guidelines, there was an improvement in quality of life indices, decreased rates of recurrent bacterial infections. At the same time, 40% of them continued to suffer, on average, 5.4±1.1 times a year and required long-term courses of antibiotic therapy. Evaluation of immune status did not reveal statistically significant differences in IgG plasma saturation between the groups of patients with different treatment efficiency: 8.7 (8-9) g/l and 9.1 (8.5-10.5) g/l, at p = 0.5. The differences related to immune cell factors in cases of smaller effect of IVIG therapy are manifested in higher relative numbers of T effectors containing lytic Granzyme B granules and CD14+CD284+ monocytes, accompanied by lower spontaneous active oxygen forms produced by neutrophils, lesser contents of CD16+ natural killers in peripheral blood.The obtained data illustrate the value of monitoring, not only serum IgG level, but also the parameters of the cellular immune response. Such analysis may be essential as a prognostic criterion for efficacy of IVIG therapy. Reduced levels of some parameters of innate immunity cells serves a basis to formulate the concept of combined treatment and usage of tools that alter functions of immunocompetent cells.L. P. SizyakinaI. I. AndreevaD. I. DanilovaSPb RAACIarticlecvidivig replacement therapycellular immunityImmunologic diseases. AllergyRC581-607RUMedicinskaâ Immunologiâ, Vol 22, Iss 4, Pp 799-804 (2020)
institution	DOAJ
collection	DOAJ
language	RU
topic	cvid ivig replacement therapy cellular immunity Immunologic diseases. Allergy RC581-607
spellingShingle	cvid ivig replacement therapy cellular immunity Immunologic diseases. Allergy RC581-607 L. P. Sizyakina I. I. Andreeva D. I. Danilova Importance of cellular immunity link for efficiency of replacement therapy in common variable immune deficiency
description	Lifetime use of IgG replacement therapy is the standard of CVID treatment. However, full control over stabilization of chronic infection loci is not always achieved, even if this therapy is continuously applied. The purpose of this study was to carry out comparative analysis of changes in cellular component of adaptive and innate immune response, depending on effectiveness of replacement therapy of patients with infectious CVID phenotype. The observation group consisted of 15 patients with CVID who were diagnosed since early childhood in 100% of cases. They had prolonged respiratory infections followed by the development of complications requiring continuous treatment with antibiotics.After reaching mean age of 15 years old, the intensity of infection-associated antibody deficiency was 6-8 times per year. After verification of the diagnosis, the patients received replacement therapy, first at the saturation dose, and, after stabilization of IgG at the level of 7-8 g/l, at the monthly maintenance dose. The clinical course of the disease was traced during a full year of replacement therapy, and the cellular immunity indices were evaluated. In all patients, after a year of therapy corresponding to clinical guidelines, there was an improvement in quality of life indices, decreased rates of recurrent bacterial infections. At the same time, 40% of them continued to suffer, on average, 5.4±1.1 times a year and required long-term courses of antibiotic therapy. Evaluation of immune status did not reveal statistically significant differences in IgG plasma saturation between the groups of patients with different treatment efficiency: 8.7 (8-9) g/l and 9.1 (8.5-10.5) g/l, at p = 0.5. The differences related to immune cell factors in cases of smaller effect of IVIG therapy are manifested in higher relative numbers of T effectors containing lytic Granzyme B granules and CD14+CD284+ monocytes, accompanied by lower spontaneous active oxygen forms produced by neutrophils, lesser contents of CD16+ natural killers in peripheral blood.The obtained data illustrate the value of monitoring, not only serum IgG level, but also the parameters of the cellular immune response. Such analysis may be essential as a prognostic criterion for efficacy of IVIG therapy. Reduced levels of some parameters of innate immunity cells serves a basis to formulate the concept of combined treatment and usage of tools that alter functions of immunocompetent cells.
format	article
author	L. P. Sizyakina I. I. Andreeva D. I. Danilova
author_facet	L. P. Sizyakina I. I. Andreeva D. I. Danilova
author_sort	L. P. Sizyakina
title	Importance of cellular immunity link for efficiency of replacement therapy in common variable immune deficiency
title_short	Importance of cellular immunity link for efficiency of replacement therapy in common variable immune deficiency
title_full	Importance of cellular immunity link for efficiency of replacement therapy in common variable immune deficiency
title_fullStr	Importance of cellular immunity link for efficiency of replacement therapy in common variable immune deficiency
title_full_unstemmed	Importance of cellular immunity link for efficiency of replacement therapy in common variable immune deficiency
title_sort	importance of cellular immunity link for efficiency of replacement therapy in common variable immune deficiency
publisher	SPb RAACI
publishDate	2020
url	https://doaj.org/article/f0bad738bf3d4c41a2eb983efc55e517
work_keys_str_mv	AT lpsizyakina importanceofcellularimmunitylinkforefficiencyofreplacementtherapyincommonvariableimmunedeficiency AT iiandreeva importanceofcellularimmunitylinkforefficiencyofreplacementtherapyincommonvariableimmunedeficiency AT didanilova importanceofcellularimmunitylinkforefficiencyofreplacementtherapyincommonvariableimmunedeficiency
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Importance of cellular immunity link for efficiency of replacement therapy in common variable immune deficiency

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